Li Jin-Gao, Venigalla Praveen, Leeman Jonathan E, LaPlant Quincey, Setton Jeremy, Sherman Eric, Tsai Jillian, McBride Sean, Riaz Nadeem, Lee Nancy
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A.
Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China.
Laryngoscope. 2017 Feb;127(2):377-382. doi: 10.1002/lary.26139. Epub 2016 Jul 20.
To evaluate the sites of nodal failure (NF) of nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).
Retrospective chart review.
We reviewed the records of 165 patients with nonmetastatic NPC treated with IMRT between July 1998 and April 2011 at our institution. Recurrent nodes were delineated on imaging and coregistered with the original treatment planning computed tomography. Failures were assessed as in-field, out-field, or marginal based on the relative volumes of the recurrent nodes covered by the original dose distribution.
Ten patients had NF at a median follow-up of 70.4 months for surviving patients. The 3- and 5-year overall survival and NF rates were 88.7%, 76.0% and 5.8%, 7.7%, respectively. Six of the nodal failures were in-field, of which five occurred in level II; whereas four had out-field failures, all of which were in the protected parotid gland area. There were no recurrences in level 1b despite this region being protected. The cumulative 3- and 5-year failure rates in the parotid gland area were 2.2% and 3.1%, respectively. Three patients with parotid failure initially had subcentimeter, nonspecific nodules in the same locations of the parotid gland as the recurrent nodes.
Nodal failure is uncommon after IMRT in NPC. Recurrence in the parotid gland region accounts for all of the out-field failures and 40% of NF in our study. Comprehensive assessment of nodules in or around the parotid gland is therefore a key aspect of treatment planning and follow-up.
评估接受调强放射治疗（IMRT）的鼻咽癌（NPC）患者的区域淋巴结复发（NF）部位。
回顾性病历审查。
我们回顾了1998年7月至2011年4月在我院接受IMRT治疗的165例非转移性NPC患者的记录。在影像学上勾勒出复发淋巴结，并与原始治疗计划计算机断层扫描进行配准。根据复发淋巴结被原始剂量分布覆盖的相对体积，将复发评估为野内、野外或边缘复发。
10例患者出现NF，存活患者的中位随访时间为70.4个月。3年和5年总生存率及NF发生率分别为88.7%、76.0%和5.8%、7.7%。6例区域淋巴结复发为野内复发，其中5例发生在Ⅱ区；4例为野外复发，均发生在腮腺保护区域。尽管1b区受到保护，但该区域未出现复发。腮腺区域3年和5年累积复发率分别为2.2%和3.1%。3例腮腺复发患者最初在腮腺与复发淋巴结相同位置有小于1厘米的非特异性结节。
NPC患者接受IMRT后区域淋巴结复发并不常见。在我们的研究中，腮腺区域复发占所有野外复发的全部以及40%的区域淋巴结复发。因此，对腮腺内或其周围结节的综合评估是治疗计划和随访的关键方面。
4。《喉镜》，2016年1月，第127卷：377 - 382页，2017年。
